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A Celebration of Midwifery – Supporting Safe, Healthy Birth!

July 1st, 2014 by avatar

In June, midwives were making news all around the world in person and in print.   Maternity care researcher Judith Lothian presented at the International Congress of Midwives conference in Prague, an enormous international gathering of thousands of midwives from all the corners of the globe that occurs every three years. Dr. Lothian shares her impressions of the Congress gathering today.  Additionally, the journal, The Lancet released its Series on Midwifery, long awaited and recognizing that if normal, safe birth is to be supported, midwifery care is the key to achieving that goal.  Dr Lothian summarizes this important series and shares what it means for women and their babies. – Sharon Muza, Community Manager, Science & Sensibility

@ Barbara Harper

@ Barbara Harper

In the US, where midwives attend around 10% of births and around 1% of women have planned out of hospital births, most women and many health care providers know little, if anything, about midwifery. Several decades ago, I began to write about midwifery and out of hospital birth as a way of promoting, protecting and supporting normal birth.  More recently, I’ve done research on women’s and midwives’ experiences of home birth. I’ve also spent a great deal of time with midwives, with my daughters during the births of my grandchildren, at two historic Home Birth Summits, at Normal Birth conferences and, in the last 2 years working with the American College of Nurse Midwives on their Normal Birth Initiative. I count many midwives among my most respected and cherished friends.

I’ve wanted to spread the good news about midwifery and women and babies for a very long time, but the last month has me wanting to ring bells, light candles, and shout from the rooftops to celebrate the tremendous accomplishments of midwives and midwifery, the courage of midwives, and the commitment of midwifery to women and children here in the United States and across the globe.

In early June I attended the International Congress of Midwives in Prague. Thirty eight hundred midwives (and a smaller group of nurses, sociologists, epidemiologists, birth advocates and researchers) came together as they do every three years to share what they know, learn what they don’t know, and recommit themselves to women and babies around the world.  Midwives from 85 countries, most often in the traditional dress of their country, paraded into the opening ceremony. The video and pictures from this event can’t begin to capture what it was like to be there, but it does give you a taste of the excitement and the pride.  It was truly amazing.

ICM.Frances_open

@ Barbara Harper

The number of sessions was mind boggling. In each time slot there were multiple sessions on normal birth. It was difficult to choose and impossible to get to even a small percentage of what was offered. I am sharing some of the standouts for me.

Lisa Kane Low, from the University of Michigan, and a champion of midwifery and evidence based maternity care, was a plenary speaker. Her talk on access to care highlighted the importance of meeting women where they are and putting their needs, not ours, first. Toyin Saraki is the newly appointed ICM Global Goodwill Ambassador. The former First Lady of Nigeria, she is the founder and director of the Wellbeing Foundation Africa. The work of the foundation has reduced maternal mortality in Nigeria by 20%.

Ms. Saraki shared a Nigerian saying with us: If you want to go fast, go alone. If you want to go far, go together.  I can’t stop thinking about that, and its implications for our work.  Cecily Begley, the Chair of Nursing and Midwifery at Trinity College Dublin, participated in a plenary panel, Education: The Bridge to Midwifery and Women’s Autonomy. Professor Begley talked about “communities of change” and she described education and research as necessary in crossing the bridge to change. Ray DeVries and Saras Vedam participated in a symposium on ethics related to birth place. Both Ray and Saras contributed to the Journal of Clinical Ethics Fall 2013 special issue on place of birth. The audience participation was lively.

© Barbara Harper

© Barbara Harper

The ethical issues related to pushing women to unassisted births when there is no real choice related to planned, assisted out of hospital birth and the ethical issues of hospitals and providers stonewalling efforts to make transfer seamless, safe, and without recrimination were discussed. Dr. Marianne Nieuwenhuijze from the Netherlands, presented her excellent work on shared decision making. Tanya Tanner from ACNMEllie Daniels from National Association of Certified Professional Midwives, and I presented the collaborative work of ACNM, MANA and NACPM developing a consensus statement on normal, physiologic birth, and more specifically, our work developing a consumer statement based on the consensus statement, Normal, Healthy Childbirth for Women and Families: What You Need to Know.

It was wonderful meeting midwives from Australia, Canada, Ghana, the UK, and Ireland. The challenges are not exactly the same as ours in the US, but we are all fighting uphill battles in support of normal birth.

On the heels of the ICM, The Lancet launched its eagerly awaited Lancet Series on Midwifery.  In Ireland for the summer, I was glued to my computer savoring every moment of the launch online on June 23.    The lead author of each of the four major papers provided a summary and there were comments from a wide array of noted scholars, researchers, practitioners and policy makers from around the world. There were many familiar faces from the International Congress of Midwives. Toyin Saraki gave a stirring speech applauding midwifery, noting that midwifery is not a job, but a passion, a vocation.  Holly Kennedy, who co-authored a paper, and is working on a follow up paper, brought congratulations from the ACNM.

Why did the Lancet do a series on midwifery? Richard Horton, who was involved in the project from the beginning , has this to say in his commentary, The Power of Midwifery:

“Midwifery is commonly misunderstood. The Series of four papers and five Comments we publish today sets out to correct that misunderstanding. One important conclusion is that application of the evidence presented in this Series could avert more than 80% of maternal and newborn deaths including stillbirths. Midwifery therefore has a pivotal, yet widely neglected, part to play in accelerating progress to end preventable mortality of women and children”.  Horton and Astudillo  go on to note that the work is based on a set of values and philosophy that are distinctive. “These values include respect, communication, community knowledge and understanding, and care tailored to a woman’s circumstances and needs. The philosophy is equally important—to optimise the normal biological, psychological, social, and cultural processes of childbirth, reducing the use of interventions to a minimum. “

The four papers include

  • Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care by Mary J Renfrew, Alison McFadden, Maria Helena Bastos, James Campbell, Andrew Amos Channon, Ngai Fen Cheung, Deborah Rachel Audebert Delage Silva, Soo Downe, Holly Powell Kennedy, Address Malata, Felicia McCormick, Laura Wick, Eugene Declercq
  • The projected effect of scaling up midwifery by Caroline S E Homer, Ingrid K Friberg, Marcos Augusto Bastos Dias, Petra ten Hoope-Bender, Jane Sandall, Anna Maria Speciale, Linda A Bartlett
  • Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality by Wim Van Lerberghe, Zoe Matthews, Endang Achadi, Chiara Ancona, James Campbell, Amos Channon, Luc de Bernis, Vincent De Brouwere, Vincent Fauveau, Helga Fogstad, Marge Koblinsky, Jerker Liljestrand, Abdelhay Mechbal, Susan F Murray, Tung Rathavay, Helen Rehr, Fabienne Richard, Petra ten Hoope-Bender, Sabera Turkmani
  • Improvement of maternal and newborn health through midwifery by Petra ten Hoope-Bender, Luc de Bernis, James Campbell, Soo Downe, Vincent Fauveau, Helga Fogstad, Caroline S E Homer, Holly Powell Kennedy, Zoe Matthews, Alison McFadden, Mary J Renfrew, Wim Van Lerberghe

The Lancet Series on Midwifery makes a major contribution to the literature bringing together the evidence basis for midwifery, its outcomes, and how to affect policy. We need to translate that evidence into action, into the education of the women we teach, and into our advocacy efforts on behalf of safe, healthy birth.

The Lancet Series on  Midwifery can be accessed at through this link. The series includes an executive summary, commentaries, and the four major papers. You need to register on the Lancet site but everything can be accessed for free.

The time has come to recognize and celebrate the incredible work that midwives do. In the US, it is time for women to know about midwifery, and to see the connection of midwifery and normal, physiologic birth.  It is time for childbirth educators to encourage women to choose midwifery care, and time to collaborate with midwives both in our communities and on organizational and governmental levels.  If we want to promote safe, healthy, normal physiologic birth, we need to promote and support midwifery. Healthy low risk women need to know that if they want the safest, healthiest birth for themselves and their babies that they need to find a midwife.

About Judith Lothian

@ Judith Lothian

@ Judith Lothian

Judith Lothian, PhD, RN, LCCE, FACCE is a nurse and childbirth educator. She is an Associate Professor at the College of Nursing, Seton Hall University and the current Chairperson of the Lamaze Certification Council Governing Body. Judith is also the Associate Editor of the Journal of Perinatal Education and writes a regular column for the journal. Judith is the co-author of The Official Lamaze Guide: Giving Birth with Confidence. Her research focus is planned home birth and her most recent publication is Being Safe: Making the Decision to Have a Planned Home Birth in the US published in the Journal of Clinical Ethics (Fall 2013).

Evidence Based Medicine, Guest Posts, Home Birth, Maternal Quality Improvement, Maternity Care, Midwifery , , , , , , ,

Midwifery As A Birth Option? – Tools for Educators to Share with Families

May 29th, 2014 by avatar

By Nasima Pfaffl, President, Citizens for Midwifery

midwife care

© Richard Kimbrough

Childbirth education students are typically attending classes in the last trimester of their pregnancy. Most likely, they have established care with a health care provider months ago. Families may receive care from obstetricians, family practice doctors or midwives and find themselves sitting next to each other in class. Conversations may come up in class about the type of care they are receiving. Some families, for a variety of reasons, may be considering changing providers. The educator may be asked what is the difference between the different types of providers who might help them with their birth. Today, guest contributor Nasima Pfaffl shares information about the midwifery model of care, for those families that are interested in pursuing care with a midwife. In future posts, a family practice doctor and an obstetrician will explain more about the type of care they provide. – Sharon Muza, Community Manager, Science & Sensibility.

At Citizens for Midwifery, we get frequent requests for information about birth with a midwife. Is it safe? What training does a midwife have? How is midwifery care different than other care?

We’ve pulled together some of our favorite resources for you to use as you educate families about their birth options. We hope you’ll share with us your favorites that we’ve missed, in the comments section below.

Are there different kinds of midwives?

Yes. There are two main categories of midwives in the U.S., nurse-midwives, who are trained in both nursing and midwifery, and direct entry midwives, who trained as midwives without being nurses first. The majority of direct entry midwives are Certified Professional Midwives (CPMs); but this category also includes Certified Midwives and Licensed/Registered Midwives. The legal status of direct entry midwives varies in different states. The Midwives Alliance of North America (MANA) has good information on the kind of care direct entry midwives provide.

Direct entry midwives include highly trained and very competent midwives; however, anyone may call him/herself a midwife at this time, and if you are looking for a midwife, it is up to you to find out if the midwife is qualified and experienced to your satisfaction. If a midwife is a Certified Professional Midwife (CPM), you are assured that s/he has met specific requirements for certification (and recertification every three years).

Consumers can learn more about the CPM credential and why state licensing of midwives is important from the North American Registry of Midwives (NARM). Many states are also working on bills to license CPMs (check your state here at the Big Push site). The National Association of Certified Professional Midwives has resources about how CPMs practice and how midwifery organizations are working to integrate CPMs into the health care system.

Is midwifery care safe?

Midwifery care is generally provided for people who are at low-risk for complications during pregnancy and birth in one of three settings: hospital, home, or birth centers.

Many of the questions around safety center around home and hospital births. A recent study of birth center births found that people experienced very low cesarean rates, and stillborn and newborn death rates comparable to rates seen in other low-risk populations.

A growing body of research shows that, for low-risk  people, home birth results in fewer interventions for the birthing parent and is safe for the baby. Citizens for Midwifery summarized the recent study published in the Journal of Midwifery and Women’s Health.  Judith Lothian also wrote a good summary in a previous post on Science & Sensibility. A helpful bibliography that outlines the research – and the quality of that research – around home birth can provide additional information.

What does midwifery care look like?

Midwifery care in the United States varies widely by provider and setting. The Midwives Alliance of North America is launching a series of videos called “I am a Midwife” to educate consumers on common questions about midwife led care, including safety, training, how midwives collaborate with other health professionals, and how midwives and families work together to make decisions about care. You can watch the video and sign up for updates here.

 

Brochures describing the Midwives Model of Care are also available from Citizens for Midwifery. These brochures can be very helpful in describing the kind of care midwives provide.

Is midwifery care available in my community?

This depends on what kind of care you are looking for. Midwives are available in many, but not all, hospital settings. You may need to search a few different resources to get a complete picture of what is available in your community.

The Find A Midwife Tool from the American College of Nurse Midwives can help you locate certified nurse midwives and certified midwives.

Mothers Naturally’s Find A Midwife Tool can help you identify midwives who are members of the Midwives Alliance of North America. They have members of all credentials.

The Birth Center locator will find the 10 birth centers closest to you (which could be quite far, depending on the legal status of your state).

If you have families in your classes exploring pregnancy and birth care with a midwife, these resources that you can share may answer questions and help them to decide what type of provider is the right one for them.  What resources do you like sharing in your classes on the different types of care available?  Let us know in the comments section. – SM

About Nasima Pfaffl

Nasima Pfaffl HeadshotNasima Pfaffl, MA is a medical sociologist with a focus on social movements and women’s health. She is a second generation home birth mom. She is the current president of Citizens for Midwifery and has served on the board since 2006. She worked for the Midwifery Education Accreditation Council as their Accreditation Coordinator. She served on the MAMA Campaign steering committee, on the Birth Network National Board, the Coalition for Improving Maternity Services Leadership Team (Board), and as the Grassroots Advocates Committee Co-Chair and Survey Team Lead for The Birth Survey. Nasima focuses on coalition building and utilizing capacity building technologies and tools to make midwifery advocacy organizations stronger, more effective and able to create the change needed in our broken maternity care system. She lives in Florida with her son, daughter and husband. Nasima can be reached by email – nasima@cfmidwifery.org

 

Childbirth Education, Guest Posts, Maternity Care, Midwifery , , , , , , , , ,

Thank You Midwives! Celebrate International Day of the Midwife Today!

May 5th, 2014 by avatar

2014 day of midwife_600pxMay 5th has been recognized as the International Day of the Midwife since 1992. The International Confederation of Midwives (ICM) supports, represents and works to strengthen professional associations of midwives throughout the world.  The purpose of this day is to “celebrate midwifery and to bring awareness of the importance of midwives’ work to as many people as possible.” There are currently 108 Midwives Associations, representing 95 countries across every continent. ICM is organized into four regions: Africa, the Americas, Asia Pacific and Europe. Together these associations represent more than 300,000 midwives globally.

Midwives play a crucial role in maternal and infant health.  This year’s theme is “Midwives: changing the world one family at a time.” There are many key messages that highlight how midwives around the world are helping mothers, babies, families and communities.  Some of these global messages, backed up by research and investigation include:

  • In midwife-led care, women experience less preterm births, less assisted deliveries and greater satisfaction with care.
  • Midwives change the world by caring for mothers and babies. By caring for them, midwives help ensure that women are healthy, thus contributing to a strong community and economy. When babies survive, they start growing into healthy children and adults.
  • If every childbearing woman received care with a well- educated, adequately resourced midwife, most of maternal and newborn deaths could be prevented.
  •  Investments in midwifery education as well as regulation, provision of infrastructure and information will improve access to midwifery care
  •  Midwifery services are economic and cost effective.
  •  Investment in midwives means commitment to a healthy and wealthy nation.

In many countries around the world, access to maternity care is limited by economics, social status, distance and many other factors.  Trained and qualified midwives can have a significant impact on mortality rates for mothers and babies worldwide.  For healthy, low risk women in developed countries, midwifery care is appropriate, cost effective and provides excellent outcomes for mothers and babies.

Are you or your community doing anything special to honor the midwives who work in your area?  Let us know some of the events planned.

Please join  Lamaze International, Science & Sensibility and myself in celebrating the women and men (yes, men are midwives too!) who serve as midwives to our partners, our wives, our sisters, our friends, our daughters and granddaughters all around the world.  Take a moment to thank them for their hard work and the gentle care they provide to birthing women and families.  You may want to send a customized “International Day of the Midwife” ecard to your favorite midwife, and  thank them for their contribution to healthy mothers and babies.  I am going to take a few minutes today to thank the midwives in my community for taking good care of families in my area.

Additionally, as an avid reader of books, I thought in honor of the International Day of the Midwife that I would share some of my favorite books that I have read about midwives.  I would love to hear your suggestions for future reading on this topic, as I enjoy the genre and would welcome your reading suggestions in our comments section.

Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent

Lady’s Hands, Lion’s Heart: A Midwife’s Saga – by Carol Leonard

The Birth House - by Ami McKay

The Midwife of Hope River – Patricia Harman

The Blue Cotton Gown: A Midwife’s Memoir – Patricia Harman

Arms Wide Open: A Midwife’s Journey – Patricia Harman

A Midwife’s Story  – Penny Armstrong and Sheryl Feldman

Orlean Puckett: Life of a Mountain Midwife - Karen Cecil Smith

Monique and the Mango Rains: Two Years with a Midwife in Mali - Kris Holloway

The  Midwife: A Memoir of Birth, Joy and Hard Times – Jennifer Worth

Call the Midwife: Shadows of the Workhouse – Jennifer Worth

Call the Midwife: Farewell to the East End – Jennifer Worth

A Midwife’s Tale: The Life of Martha Ballard, Based on her Diary, 1785-1812 – by Laura Thatcher Ulrich

Laboring: Stories of a New York City Hospital Midwife  by Ellen Cohen

The Midwife’s Apprentice – by Karen Cushman

Listen to Me Good: The Story of an Alabama Midwife – by Margaret Charles Smith

Babies, Home Birth, Maternal Mortality, Maternal Mortality Rate, Midwifery , , , ,

The Childbirth Educator’s Role in The Cesarean Epidemic: 10 Steps You Can Take Now!

April 29th, 2014 by avatar

As Cesarean Awareness Month (April 2014) comes to a close, I wanted to share ten things that childbirth educators can do in their childbirth classes to support families to avoid unneeded cesareans, help families to have a cesarean birth that is respectful and family centered and support families who give birth by cesarean, (planned or unplanned) both during the birth, in the postpartum period and when planning future births.

1. Birth plan exercises

Have your birth planning/birth choices activity include preferences for a cesarean birth.  Allow parents the option to select items such as delayed cord clamping, skin to skin in the operating room, delaying newborn weights and measurements, and more.  While these may not be available options in all areas, encouraging discussion amongst families and their health care providers is a good place to start.  Additionally, consider role playing a cesarean section in class and discuss ways to make the procedure family friendly.  Remember to suggest ways that the partner and other support people can best support mother and baby during the surgery. Consider sharing “The natural caesarean: a woman-centred technique” video so families can explore options for a family friendly cesarean birth.

2. Access teaching resources on the Lamaze International website

Lamaze International offers some great teaching resources on cesareans for educators on their website and for families on the Lamaze International parent site.  There are two infographics that cover the topic of cesarean sections; “Avoiding the First Cesarean” and “What’s the Deal with Cesareans.”  You might consider showing the brand new infographic video to your families in class. At only 3 minutes long, it does a great interactive job of highlighting important information. In addition to using these materials in class, encourage families to explore them more thoroughly at home.

3.  Provide current statistics

Access and share statistics about national and provincial or state cesarean rates and VBAC rates, along with local rates for facilities and providers if available.  Help your families to understand the difference between overall cesarean rates and primary cesarean rates and why facilities caring for high risk mothers or babies might have higher rates.  Make sure that you are providing the most current information available, and update your figures when new numbers are released. Encourage discussion in class with families who are considering changing birth location or providers if they feel so inclined.

4. Encourage the use of birth doulas

The addition of trained labor support has been shown to reduce common interventions and cesareans. (Hodnett, 2012)  Take some time during class to share how doulas can help support both the laboring woman and her partner and team.  Provide resources for families to locate doulas (DONA.org and DoulaMatch.net are two such lists that come to mind) and briefly share information on questions to ask a doula during an interview, so the families are prepared.

cam two ribbon5.   Share current best practice information

Be sure that the information in your classes is current, accurate and based on best practices and evidence.  Know the sources of the information you cover.  Make sure it is up to date and verifiable.  Have a short list of favorite online resources to share with families, including Lamaze International’s Giving Birth with Confidence blog- written specifically for parents.  Utilize the references that make up the Six Healthy Birth Practices, there is a citation sheet for all six of the birth practices.

6. Support the midwifery model of care

Share information in your classes about the midwifery model of care, which has been shown to be an appropriate choice for healthy, low risk women.  Let your class families know how to find a midwife by using the search functions on the American College of Nurse-Midwives website and information on finding a midwife on the Citizens for Midwifery website.

7. Have meaningful class reunions

If your childbirth class includes a reunion, create a space for all the families to share their stories, both the vaginal births and the cesarean births.  Honor the work that the families did to birth their babies and celebrate their intention and teamwork.  Highlight their shining moments and let them know that you recognize how hard they worked.  Model excellent listening skills and support all the families as they share their birth stories.

8. Provide support group information

Make sure that all families that leave your class have been given resources for a support group for women who birth by cesarean section.  Access the International Cesarean Awareness Network (ICAN) to find the nearest local ICAN chapter website or Facebook group. Or refer the families to the main ICAN Facebook page.  VBACFacts.com also has a large peer to peer support network active on Facebook as well.

9.  Share postpartum resources

Families that birth by cesarean section might find themselves needing additional support from professionals during the postpartum period.  Be sure that they have resources to find lactation consultants, mental health counselors, postpartum doulas, physical therapists and other professionals that might be useful for healing emotionally and physically from a cesarean section.  In the throes of postpartum hormones, exhaustion, sleep deprivation and physical recovery, having to hunt down appropriate professionals can be a daunting task for any new families, never mind a mother recovering from surgery with a newborn.

10.  Offer a cesarean only class

Some families know they will be needing a cesarean for maternal or infant health circumstances and are hesitant about taking the standard childbirth class, feeling like they won’t fit in.  While they may not be needing the coping skills or comfort techniques and pushing positions that you cover in the typical childbirth class, they do need information about the cesarean procedure, pain medication options, recovery, breastfeeding and newborn care/procedures and informed consent and refusal information, among other things.  Having a class designed with their needs in mind can help them to make choices that feel good to them and participate in the community building that is such an important part of childbirth classes.

Don’t underestimate the role of the childbirth educator (you!) to offer evidence based information, appropriate resources, respectful dialogue along with skills and techniques to help women to have the best birth possible, avoid a cesarean that is not needed and recover and heal  while feeling supported with options for future births.  Thank you for all you do to help women to avoid cesareans or if needed, have the best cesarean possible.

References

Hodnett, E. D., S. Gates, et al. (2012). “Continuous support for women during childbirth.” Cochrane database of systematic reviews: CD003766.

Cesarean Birth, Childbirth Education, Giving Birth with Confidence, Healthy Birth Practices, Lamaze International, Maternal Quality Improvement, Maternity Care, Medical Interventions, Midwifery, Practice Guidelines, Vaginal Birth After Cesarean (VBAC) , , , , , , ,

The Best Practice Guidelines: Transfer from Home Birth to Hospital – Collaboration Can Improve Outcomes

April 17th, 2014 by avatar

 By Lawrence Leeman, MD, MPH and Diane Holzer, LM, CPM, PA-C

© http://www.mybirth.com.au/

© http://www.mybirth.com.au/

On Tuesday, readers learned about the history and objectives of the Home Birth Consensus Summit, a collective of stakeholders, whose goal is to improve maternal infant health outcomes and increase collaboration between all those involved in serving women who are planning home births.  The interdisciplinary collaboration that occurs during the Summits brings representatives from many different perspectives to the table in order to improve the birth process for women and babies. You may want to start with the post “Finding Common Ground: The Home Birth Consensus Summit” and then enjoy today’s post on the Home Birth Consensus Summit’s just released “The Best Practice Guidelines: Transfer from Home Birth to Hospital.”  Today’s post was written by Dr. Lawrence Leeman and Midwife Diane Holzer, two of the members on the HBCS Collaboration Task Force, a subgroup tasked with developing these transfer guidelines.  Share your thoughts on these new guidelines and your opinion on if you feel that they will improve safety and outcomes for mothers and babies. – Sharon Muza, Community Manager, Science & Sensibility

Leea Brady was a second-time mother whose first baby was born at home. One day past her due date, an ultrasound revealed high levels of amniotic fluid, which can pose a risk during delivery. Although she planned to have her baby at home, on the advice of her midwife, Leea transferred to her local hospital.

“I knew that we needed to be in the hospital in case anything went wrong,” said Brady. “I was really surprised when I arrived and the hospital staff told me they had read my birth plan, and they would do everything they could to honor our intentions for the birth. My midwife was able to stay throughout the birth, which meant a lot, because I had a trusting relationship with her. She clearly had good relationships with the hospital staff, and they worked together as a team.”

A recent descriptive study (Cheyney, 2014) reports that about ten percent of women who plan home births transfer to the hospital after the onset of labor. The reason for the overwhelming majority of transfers are the need for labor augmentation and other non-emergent issues. Brady’s transfer from a planned home birth to the hospital represents the ideal: good communication and coordination between providers in different settings, minimizing the potential for negative outcomes.

However, in some communities, lack of trust and poor communication between clinicians during the transfer have jeopardized the physical and emotional well being of the family, and been frustrating for both transferring and receiving providers. Lack of role clarity and poor communication across disciplines have been linked to preventable adverse neonatal and maternal outcomes, including death.(Guise, 2013,Cornthwaite, 2008) With optimal communication and cooperation among health care providers, though, families often report high satisfaction, despite not being in the location of their choice.

Recent national initiatives have been directed at improving interprofessional collaboration in maternity care.(Vedam, 2014) This is why a multi-disciplinary working group of leaders from obstetrics, family medicine, pediatrics, midwifery, and consumer groups came together to form a set of guidelines for transfer from home to hospital. The Best Practice Guidelines: Transfer from Planned Home Birth to Hospital are being officially launched today by the Home Birth Consensus Summit and will be highlighted at a series of upcoming presentations at conferences and health care facilities.

The authors of the guidelines, known as the Home Birth Summit Collaboration Task Force, formed as a result of their work together at the Home Birth Summits.

© http://flic.kr/p/3mcESR

© http://flic.kr/p/3mcESR

“Some hospital based providers are fearful of liability concerns, or they are unfamiliar with the credentials and the training of home birth providers,” said Dr. Timothy Fisher, MD, MS, at the Hubbard Center for Women’s Health in Keene, NH and an Adjunct Assistant Professor of Obstetrics and Gynecology, Dartmouth Medical School. “But families are going to choose home birth, for a variety of cultural and personal beliefs. These guidelines are the first of their kind to provide a template for hospitals and home birth providers to come together with clearly defined expectations.”

The guidelines provide a roadmap for maternity care organizations developing policies around the transfer from home to hospital. They are also appropriate for transfer from a free-standing birth center to hospital.

The guidelines include model practices for the midwife and the hospital staff. Some guidelines include the efficient transfer of records and information, a shared-decision making process among hospital staff and the transferring family, and ongoing involvement of the transferring midwife as appropriate.

“When the family sees that their midwife trusts and respects the doctor receiving care, that trust is transferred to the new provider,” said Dr. Ali Lewis, a member of the HBCS Collaboration Task Force. She became involved with the work of the committee in part because of her experiences with a transfer that was not handled optimally. “It is rare that transfers come in as true emergency. But when they do, if the midwife can tell the family she trusts my decisions, then I can get consent much more quickly, which results in better care and higher patient satisfaction.”

The guidelines also encourage hospital providers and staff to be sensitive to the psychosocial needs of the woman that result from the change of birth setting.

“When families enter into the hospital and feel as if things are being done to them as opposed to with them, they feel like a victim in the process,” said Diane Holzer, LM, CPM, PA-C, and the chair of the HBCS Collaboration Task Force. “When families are incorporated in the decision-making process, and feel as if their baby and their body is being respected, they leave the hospital describing a positive experience, even though it wasn’t what they had planned.”

The guidelines are open source, meaning that hospitals and practices can use or adapt any part of the guidelines. The Home Birth Summit delegates welcome endorsements of the guidelines from organizations, institutions, health care providers, and other stakeholders.

References

Cornthwaite, K., Edwards, S., & Siassakos, D. (2013). Reducing risk in maternity by optimising teamwork and leadership: an evidence-based approach to save mothers and babies. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(4), 571-581.

Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014). Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women’s Health.

Guise, J. M., & Segel, S. (2008). Teamwork in obstetric critical care. Best Practice & Research Clinical Obstetrics & Gynaecology, 22(5), 937-951.

Vedam S, Leeman L, Cheyney M, Fisher T, Myers S, Low L, Ruhl C. Transfer from planned home birth to hospital: inter-professional collaboration leads to quality improvement . Journal of Midwifery and Women’s Health, November 2014, In Press.

About the Authors:

leeman larry headshotDr. Lawrence Leeman, MD, MPH/Medical Director, Maternal Child Health, received his degree from University of California, San Francisco in 1988 and completed residency training in Family Medicine at UNM. He practiced rural Family Medicine at the Zuni/Ramah Indian Health Service Hospital for six years. He subsequently earned a fellowship in Obstetrics. He is board certified in Family Medicine. He directs the Family Medicine Maternal and Child Health service and fellowship and co-medical director of the UNM Hospital Mother-Baby Unit. Dr. Leeman practices the family medicine with a special interest in the care of pregnant women and newborns. He is Medical Director of the Milagro Program that provides prenatal care and maternity care services to women with substance abuse problems. Dr. Leeman is a Professor in the Departments of Family & Community Medicine, and Obstetrics and Gynecology. He is currently the Managing Editor for the nationwide Advanced Life Support in Obstetrics (ALSO) program. Areas of research include rural maternity care, pelvic floor outcomes after childbirth, family planning, and vaginal birth after cesarean (VBAC). Clinic: Family Medicine Center

Diane Holzer head shotDiane Holzer, LM, CPM, PA-C, has been a practicing midwife for over 30 years with experience in both home and birth center. She was one of the founding women who passionately created an infrastructure for the integration of home birth midwifery into the system. She sat on the Certification Task Force which led to the CPM credential and also was a board member of the Midwifery Education and Accreditation council for 13 years. She served the Midwives Alliance of North America on the board for 20 years and is the chair of the International Section being the liaison to the International Confederation of Midwives. Diane is the Chair of the Collaboration Task Force of the Home Birth Summit and currently has a home birth practice and works as a Physician Assistant doing primary health care in a rural Family Practice clinic.

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